Insurers’ tactics hurt patients

Brendan McNiff

Published Thursday September 20, 2012 at 6:00 am

Updated Thursday September 20, 2012 at 1:18 pm

Emergency medical services provide peace of mind for the mom who dials 911 when her child is choking, or for a man who calls for assistance when his wife falls. The average response time for 911 calls in Massachusetts is about 8 minutes. That quick response time can mean the difference between life and death.

In 15 communities in Massachusetts, American Medical Response contracts with cities and towns to provide ambulance services. Our contracts go through a rigorous, competitive process to ensure public safety at a reasonable cost. In such a transparent transaction, there is ample opportunity to ensure that EMS rates are fair and equitable.

Based on those rates, AMR, like EMS providers across Massachusetts, assigns vehicles and trained personnel to the area and responds when someone dials 911. That’s how the system works, and until recently, it worked well. Many lives have been saved.

However, recently, insurers — primarily Blue Cross Blue Shield of Massachusetts — decided to squeeze EMS providers in an effort to drive them into their networks and pay rates that do not cover costs. They have done this in other states, like New Hampshire. In 2010 in Massachusetts, insurers began paying patients directly, rather than EMS providers, for ambulance trips.

Imagine having surgery, and afterward, Blue Cross sent you a big check so you could then pay the surgeon, the nurses, the anesthesiologist, and the hospital. Such an irresponsible stunt is ripe for fraud. Many states have banned the practice.

Blue Cross doesn’t pay less for the EMS services. They just pay the patient, and many patients keep the money. It’s the EMS team that responds to 911 calls that gets cheated. Not one cent is saved, and health care costs are not lowered at all.

We understand that these are difficult economic times, and some people might be tempted to avoid paying an ambulance bill, but AMR’s network is based on a certain amount of revenue. If the money isn’t coming in, then something has to give.

When Blue Cross’ revenue declines, they raise premiums. When we lose money, we cannot immediately reduce spending — we must continue to meet our 911 obligations to each town. AMR alone has lost millions of dollars since the direct-to-patient payments began. We employ over 700 people in Massachusetts, but we have laid off staff and are now being forced to exit markets, including Milford, Worcester, Newburyport and others.

Other health care providers have endured similar business tactics by Blue Cross. In 2011, Tufts Medical Center and its primary care physicians and pediatricians were threatened, cajoled and victimized by a public misinformation campaign.

Let’s be clear — these tactics are not designed to reduce health care costs. This is about market clout, and bigger insurance company profits.

EMS services are unique, and many managed care practices don’t apply. When someone calls 911 for an ambulance, they need care immediately. Ambulances are mobile emergency rooms, with sophisticated medical equipment and well-trained personnel. Cities and towns large and small — many without hospitals — require coverage by the EMS provider.

A bill to resolve many of these issues and reform EMS reimbursement practices passed the Legislature but died when Governor Patrick refused to sign it. The bill will be refiled next year. But that is too late for dozens of EMS workers who will lose their jobs because of the insurance companies’ hardball tactics.

When Blue Cross and other insurers lower their own costs and reduce patient premiums, we’ll know they are serious about controlling health care costs.

Until then, be assured this is all about insurance company profits. Unfortunately, it’s the patients that pay — one way or another.